The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: A systematic review and meta-analysis

Younossi, Zobair M.; Golabi, Pegah; Avila, Leyla de; Paik, James; Srishord, Manirath; Fukui, Natsu; Qiu, Ying; Burns, Leah; Afendy, Arian; Nader, Fatema

doi:10.1016/j.jhep.2019.06.021

Cited by 1,584 publications

(1,351 citation statements)

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“…The worldwide increase in obesity has not only quadrupled the number of individuals with diabetes mellitus in the past three decades but created an epidemic of steatohepatitis (NASH) of unsuspected proportions just a decade ago. The worldwide prevalence of non‐alcoholic fatty liver disease (NAFLD) is at least 55% in patients with Type 2 diabetes (T2DM) . However, it is probably higher because more than 90% of the studies used liver ultrasound for the diagnosis, which is less sensitive for intrahepatic triglyceride content than magnetic resonance‐based imaging techniques .…”

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confidence: 99%

“…The worldwide prevalence of non-alcoholic fatty liver disease (NAFLD) is at least 55% in patients with Type 2 diabetes (T2DM). 2 However, it is probably higher because more than 90% of the studies used liver ultrasound for the diagnosis, which is less sensitive for intrahepatic triglyceride content than magnetic resonance-based imaging techniques. 3 Recently, Younossi et al 4 reported the significant burden of NASH in patients with T2DM in the United States.…”

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confidence: 99%

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A diabetologist’s perspective of non‐alcoholic steatohepatitis (NASH): Knowledge gaps and future directions

Cusi

2020

Liver International

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There is a close link between steatohepatitis (NASH) and Type 2 diabetes (T2DM). Recently, the American Diabetes Association (ADA) recommended screening for NASH and advanced fibrosis in patients with diabetes and hepatic steatosis or elevated plasma alanine aminotransferase (ALT). This is because as many as ~30% to 40% may have NASH and ~10% to 15% advanced fibrosis. The role of hyperglycemia and the natural history of NASH in diabetes remain poorly understood, as well as which diagnostic algorithm or interventions are most cost‐effective. There is significant clinical inertia and most patients today are still not receiving adequate lifestyle intervention or pharmacological treatment with diabetes agents known to be effective against NASH. Lifestyle intervention improves steatohepatitis in proportion to the magnitude of weight loss, but this trend is not as consistent for regression of fibrosis. This limited success supports the need for concomitant pharmacological therapy. Pioglitazone has been shown to consistently induce resolution of NASH in both patients with or without diabetes in a total of 498 participants in five randomized controlled trials (RCTs), but with modest effects on liver fibrosis. Proof‐of‐concept studies suggest a potential role for GLP‐1RAs and SGLT2 inhibitors. Combination therapy is on the horizon. Treating diabetes and NASH with a combination of pioglitazone, GLP‐1RAs or SGLT2i, could be a cost‐effective strategy to treat both diseases while reducing their high cardiovascular risk. Future combination therapies will likely combine existing diabetes agents with novel NASH‐spechfic drugs under development. This review highlights current knowledge gaps and proposes future directions for the treatment of NASH in diabetes.

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confidence: 99%

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confidence: 99%

A diabetologist’s perspective of non‐alcoholic steatohepatitis (NASH): Knowledge gaps and future directions

Cusi

2020

Liver International

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“…Non‐alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease with increasing prevalence worldwide . NAFLD is a complex disease whose pathogenesis is dependent on an underlying genetic predisposition and several environmental factors.…”

Section: Introductionmentioning

confidence: 99%

“…Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease with increasing prevalence worldwide. [1][2][3][4][5][6][7][8] NAFLD is a complex disease whose pathogenesis is dependent on an underlying genetic predisposition and several environmental factors. 2,[9][10][11] Recent data suggest that the global prevalence of NAFLD is rising as a consequence of the pandemic of obesity, insulin resistance and diabetes mellitus, which are common risk factors for both NAFLD and cardiovascular disease (CVD).…”

Section: Introductionmentioning

confidence: 99%

The impact of modifiable risk factors on the long‐term outcomes of non‐alcoholic fatty liver disease

Paik

Deshpande

Golabi

et al. 2019

Aliment Pharmacol Ther

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Summary Background Cardiovascular (CV) disease is the leading cause of mortality in patients with non‐alcoholic fatty liver disease (NAFLD). The American Heart Association (AHA) developed 7 CV health metrics (poor, intermediate and ideal health) to improve CV health. Aim To assess population‐attributable fractions (PAFs) of CV health metrics to all‐cause and CV mortality among NAFLD patients Methods We included adult participants from National Health and Nutrition Examination Survey (NHANES 1988‐1994) with clinical and mortality data. NAFLD was defined as the presence of hepatic steatosis on ultrasonography in the absence of other chronic liver diseases and excessive alcohol use. Results A total of 4040 adults with NAFLD and 7515 without were included. NAFLD had fewer ideal health metrics than non‐NAFLD (age‐standardised prevalence: 20% vs 10% for ≤1 ideal health metric; 5.1% vs 8.7% for ≥6, all P < .001). Following median follow‐up of 19.2 years (IQR: 17.5‐21.0 years), 1,136 NAFLD subjects (327 CV deaths) and 1600 non‐NAFLD subjects (447 CV deaths) died. Increased number of ideal health metrics (all trend P < .0001) correlated with lower risk for all‐cause and CV mortality. If all NAFLD subjects achieved 7 ideal health metrics, 66% of all‐cause deaths and 83% of CV deaths were preventable. Among NAFLD subjects, lack of glycaemic control (adjusted PAF = 28.3% all‐cause; 38.1% CV) and hypertension (adjusted PAF of 23% all‐cause; 52.8% CV) were the largest mortality contributors. Ideal physical activity level obtainment provided an adjusted PAF = 13.9% all‐cause and 13.8% CV mortality. Conclusions Attainment of ideal CV health metrics provides protection against all‐cause and CV deaths in NAFLD.

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“…Non-alcoholic fatty liver disease (NAFLD) is an extremely common condition, affecting approximately 20% of adults in Western countries, with the highest prevalence of almost 75% affected subjects in the obese, diabetic population [1,2]. Based on this alarming statistic, NAFLD is considered as the leading cause of liver diseases [3].…”

Section: Introductionmentioning

confidence: 99%

Sarcopoterium spinosum Inhibited the Development of Non-Alcoholic Steatosis and Steatohepatitis in Mice

2019

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Non-alcoholic fatty liver disease (NAFLD) is a comorbidity of obesity, which gradually develops from hepatic steatosis into steatohepatitis (NASH) and eventually even into fibrosis or hepatic carcinoma. To date, there has been no specific and effective treatment for NAFLD. Sarcopoterium spinosum extract (SSE) was found to improve insulin sensitivity. Recognizing the intimate link between insulin resistance and NAFLD, the aim of this study was to investigate the effectivity of SSE in the prevention and management of NAFLD at various severities. SSE was given to high-fat diet (HFD)-fed mice (steatosis model) or to mice given a Western diet (WD) in the short or long term (NASH prevention or treatment, respectively). SSE reduced body weight accumulation, improved glucose tolerance and insulin sensitivity and prevented the development of hepatic steatosis. SSE also blocked the progression of liver disease toward NASH in a dose-dependent manner. The expression of genes involved in lipid metabolism, inflammation, and antioxidant machinery was regulated by SSE in both models of steatosis and NASH development. However, SSE failed to reverse the hepatic damage in the advanced model of NASH. In summary, SSE might be considered as a botanical supplement for the prevention and treatment of hepatic steatosis, and for slowing the deterioration toward NASH.

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The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: A systematic review and meta-analysis

Cited by 1,584 publications

References 45 publications

A diabetologist’s perspective of non‐alcoholic steatohepatitis (NASH): Knowledge gaps and future directions

A diabetologist’s perspective of non‐alcoholic steatohepatitis (NASH): Knowledge gaps and future directions

The impact of modifiable risk factors on the long‐term outcomes of non‐alcoholic fatty liver disease

Sarcopoterium spinosum Inhibited the Development of Non-Alcoholic Steatosis and Steatohepatitis in Mice

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